HomeMy WebLinkAbout973644Note to Clerk: Please Do Not put recording Information Above this Line.
Claimant, State of Wyoming, Department of Health, Division of Healthcare Financing
located at 6101 Yellowstone Road, Suite 210, Cheyenne, Wyoming 82002, hereby
releases the VERIFIED LIEN STATEMENT FOR LIEN FOR MEDICAL ASSISTANCE
which was recorded on July 22, 2013, at Book 816, Page 172, as Document No. 972126,
on property owned by Anagene Hepworth and affecting the lands described as:
The above described lien is fully released as to the above described real property,
but Claimant expressly retains and reserves the right to satisfy the remaining debt due and
owing Claimant from any and all other available assets.
Notwithstanding any other provision in this Release of Verified Lien Statement,
Claimant is not releasing or waiving any rights it has or may have to satisfy the remaining
unpaid debt from any and all other assets, including past, present, and future assets,
owned by or in which the Estate of Anagene Hepworth has an interest.
IN WITNESS WHEREOF, I do hereunder set my hand this ey of October
2013.
RECEIVED 10/9/2013 at 10:36 AM
RECEIVING 973644
BOOK: 822 PAGE: 226
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF WYOMING
ss.
COUNTY OF LARAMIE
My Commission expires: WI iNvOrit. Z,air
RELEASE OF VERIFIED LIEN STATEMENT
County of Lincoln, State of Wyoming
Lot No. 3 of Block No. 7 in the town of Grover, Lincoln County, Wyoming, excepting
there from: Beginning at the Northwest Corner of said Lot and running thence South
113 feet, thence East 124 feet, thence North 113 feet, thence West 124 feet to the
point of beginning, together with the share in the Grover Domestic Water Works,
together with all buildings, improvements, and appurtenances situate thereon and
appertaining thereto, subject to easements, reservations and restrictions and
restrictions of record.
WITNESS my hand and official seal.
State of Wyoming,
Dertment of 1-to th
I
By: Sheila McInerney
TPL Estate Recovery Specialist
This Release of Verified Lien Statement consisting of one page was subscribed,
sworn to and acknowledged before me on this 9 °cA day of 2013 by Sheila
McInerney as TPL Estate Recovery Specialist of the Wyoming Department of Health,
Division of Healthcare Financing.
Notary Public
1
BAR =A `•L
COUNTY OF
LARAMIE
NO OL C
STATE OF
WYOMING
MY CO MISSION E IRES MAR. 16, 2015
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